Staff hand hygiene monitors: How do you get them done?

ISSUE: The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings recommends monitoring adherence to hand hygiene and providing feedback to staff. We wanted to do this and determine accurate baseline compliance rates for all direct patient care areas but lacked infection control (IC) staffing to accomplish this goal. We also feared that results would be positively skewed if IC staff did the monitors. PROJECT: We utilized a high school student seeking healthcare-related work experience to conduct hand hygiene monitors in all direct patient care areas. We provided the student comprehensive education on hand hygiene requirements and developed a standardized hand hygiene data collection tool. The student spent 2 hours in each direct patient care area observing and documenting hand hygiene practices of staff. IC staff reviewed all data collected and provided feedback on compliance rate and additional education on areas for improvement to the manager of each area monitored. We sent cumulative results by discipline to nursing and physician executive leadership. RESULTS: Over a 6-week period, our student spent approximately 90 hours observing hand hygiene practices of 67 physicians and 201 nurses in 23 different direct patient care settings. All direct patient care areas were monitored at least twice. The overall compliance rate of physicians and nurses in meeting hand hygiene requirements was 54% and 70%, respectively. The greatest learning opportunity identified for improvement for all staff is to use hand hygiene before touching patients and after touching patient equipment. LESSONS LEARNED: Utilizing a student to conduct initial labor-intensive baseline hand hygiene monitors permitted our program to achieve its goal of determining a baseline compliance rate for all direct patient care areas. Furthermore, we judge that compliance was more realistically assessed by the student, who was relatively unknown to staff, than by IC staff. Finally, utilizing this strategy allowed more effective use of IC staffing resources to analyze the data and provide direct feedback and education to the patient care areas on their hand hygiene practices.